心血管术后急性肾损伤26例

Clinical summary of 26 patients with acute kidney injury after cardiovascular surgery

目的总结26例心血管术后急性肾损伤(AKI)的临床特征及治疗经验。方法选取行CRRT治疗的心血管术后急性肾损伤患者26例,分析其临床特点、疗效和预后。结果 26例中存活13例,死亡11例,自动放弃2例。死亡组APACHEⅡ评分及ATN-ISI积分分别(23.0±4.12)和(0.687±0.247),显著高于存活组的(18.2±3.22)和(0.372±0.245),差异有统计学意义(P<0.01);死亡组BuN及Scr水平分别为(29.80±14.63)mmol/L和(473.30±296.87)μmol/L,显著高于存活组的(27.54±13.80)mmol/L和(392.27±186.45)μmol/L,差异有统计学意义(P<0.05);死亡组术后发生AKI的时间为(2.0±1.3)d,明显短于存活组的(4.6±3.7)d(P<0.05);死亡组AKI以少尿型为主(8/11,72.7%),而存活组则以非少尿型为主(10/13,76.9%)。11例死亡患者中,7例死于心脏泵衰竭,4例因MOF死亡。13例存活患者均摆脱透析,肾功能完全恢复9例(占69%),部分恢复4例(占31%)。结论 APACHEⅡ和ATN-ISI评分越高,死亡率也越高。心脏泵衰竭及合并MOF是术后急性肾损伤死亡的主要原因。CRRT是治疗心血管术后急性肾损伤较为有效的方法。

Objective To summarize the clinical treatment experience of 26 patients with acute kidney injury （AKI） after cardiovascular surgery. Methods Twenty-six postcardiopulmonary patients were treated by continuous renal replacement therapy（CRRT） and the clinical characteristics of patients, curative effect of therapy and prognosis were assessed. Results Thirteen patients survived , 11 died and 2 quitted treatment for some reasons. To compare the scores of APACH Ⅱ and ATN-ISI models, the death group were significantly higher than the survival group, the difference being statistically significant[ （23.0 ± 4.12）vs（18.2 ± 3.22）, （0. 687 ± 0. 247）vs（0. 372 ± 0. 245）, P〈0.01]. BuN and Scr in the death group were obviously higher than those in the survival group, the difference being statistically significant[ （29.80± 2 14.63）vs（27.54 ± 13.80） mmol/L, （473.30 ± 296.87） vs（392.27 ± 186.45） μmol/L respectively, P 〈 0.05 ]. The initiating time of ARF after surgery in the two groups was 2.0 ± 1.3 and 4.6 ± 3.7 respectively, and the death group was earlier than the survival group （P 〈 0.05）. The majority of AKI patients in the death group were oliguric （8/11, 72.7% ）, while they were non-oliguric in the survival group （10/13, 76.9% ）. Among Ⅱ death cases, 7 died of？ cardiac pump failure and 4 died of MOF. Thirteen patients who survived were no longer dependent on dialysis. The renal function was completely recovered in 9 patients （ 6 9 % ） , and partially recovered in 4 patients （ 3 1% ） . Conclusion The scores of APACH Ⅱ andATN - ISI models have high correlations with mortality . The leading cause of death is the heart pump failure and MOF in patients with acute renal failure after cardiovascular surgery. CRRT is an efficient treatment on patients with acute kidney injury after cardiovascular surgery.